Hypertension is one of the main cardiovascular risk factors in Argentina, with a high prevalence (36%) and an important social, economic and health impact. Despite the availability of highly effective treatment and preventive strategies, only half of hypertensive patients are aware of their condition and the majority are not appropriately controlled.
The incorporation of pharmacists and the use of information & communication technologies (ICTs), are two of the strategies that have shown to be effective in the improvement of hypertensive patients’ management. This proposal is aimed at evaluating the access, acceptability, adoption and impact of an innovating program, which incorporates pharmacists, social marketing and the use of ICTs (“Health MGP” https://saludmgp.rpmplay.com/ and a mobile app) in the diagnosis, treatment, monitoring and control of hypertension in patients with different types of health coverage and from different social strata at the Municipality of General Pueyrredón, Province of Buenos Aires, Argentina. Adult residents of this city (>18 years old), excluding pregnant women, will constitute the eligible population.
A mixed-method study will be conducted. The quantitative component includes a quasi-experimental, prospective, longitudinal design, involving a cohort of hypertensive patients included in the community program. All those who give their informed consent at the pharmacy and are diagnosed as “new hypertensive” or “already diagnosed or under treatment hypertensive patient” will be included in the program. The qualitative component includes focus groups and in-depth interviews to assess program acceptability, adoption and impact at different levels. On the basis of an equity principle, the implementation of the program will be conducted in a stepwise approach, along three social strata, starting by the most vulnerable stratum, and it will have four stages: pre-implementation; initial implementation; strengthening implementation and program sustainability. The research hypothesis, the design of the implementation strategy and the evaluation framework were informed by the conceptual model for theorizing and evaluating non-adoption, abandonment, and challenges to the scale-up, spread, and sustainability of health technologies, recently published by Greenhalgh T. et al. This research will permit the assessment of the program acceptance and its valuation by users, implementers and decision-makers. Besides, it will provide information about its effect on patients’ access to health services as well as on the modification of behaviours related to the disease control and monitoring. This information will be critically important for the program scaling-up beyond this study. In addition, the implementation of deliberative dialogues and the participation of experts from the London School of Hygiene and Tropical Medicine will contribute to the diffusion, knowledge transfer and building of local capacities in implementation research.
Maria Eugenia Esandi
Pablo Salvador de la Colina
Ana Norma Talco
David Prieto Merino
- Argentina Ministry of Health, Argentina